Prostate cancer
High-risk non-metastatic prostate cancer: the devil is in the details

Walter (77 years)

Walter is a very fit 77-year-old former couch potato. Indeed, two years ago he decided that there is more to life than staring at a tv screen, and now he’s training to run the Marathon Des Sables. Good for you Walter! A PSA test was the starting point of various medical examinations with results listed below.

  • Medical history: no relevant comorbidities or medication
  • PSA: 22 ng/ml
  • Clinical stage: T3a
  • Prostate biopsy: ISUP grade group 4 [Gleason score: 4+4]
  • Bone scan: no sign of bone metastases
  • Pelvic MRI: confirmation of an extracapsular extension, suspicious right external iliac lymph node
  • Choline PET/CT: hypermetabolic right external iliac node corresponding to the suspicious pelvic MRI node. No other signs of node involvement or distant metastases
  • ECOG PS: 0

Which treatment option would you choose for this patient?